Network Contracting Representative

Job Description:

Provides analytical support for and monitors financial aspects of provider contracts and medical expense payment policies.

Job Details:

Looking for candidates that have experience with working with providers .

Job Essentials

1. Performs analysis and makes recommendations on annual fee schedule updates. Analyzes and reviews financial implications of proposed physician contracts and incentive programs.

2. Works with Provider Relations in physician negotiation and training as necessary. Works with Benefit Systems and Claims Operations to ensure proper implementation of physician fee schedules and other physician reimbursement arrangements.

3. Works with Network Services and Corporate Finance to review, analyze, and establish reimbursement rates and risk sharing for owned facilities. Works with Benefit Systems to ensure timely implementation of facility reimbursement rates.

4. Performs analysis and makes recommendations regarding non-Intermountain facility reimbursement. Responsible for negotiating effective contracts with panel facilities. Monitors contracted reimbursement rates and identifies providers in need of a contract, or contracts in need of revision.

5. Collects data and performs analysis to determine appropriate market reimbursement rates for all facility services. Investigates and develops new reimbursement methodologies.

6. Reviews and develops appropriate policies for out-of-panel reimbursement. Works with Benefit Systems and Claims Operations to ensure proper implementation of negotiated reimbursement rates and policies.

7. Monitors and performs periodic audits of actual provider reimbursement. Works with Benefit Systems and Information Systems to ensure appropriate rates have been loaded into the claims system.

8. Provides analytical support to the Health Plans Contracts & Reimbursement Committee.

9. Assists in development and monitoring of claims bundling policies and procedures. Has a full understanding of the claims systems and supporting software used on the reimbursement process.

10.Responsible for account management by ensuring that contracts are properly implemented, adhered to and serviced. Disseminates information of newly signed or amended contracts to affected parties. Provides daily and ongoing customer service for contracted vendors and providers.

Minimum Qualifications

Three years of experience in a managed care setting or in working with and analyzing contracts to gain a broad understanding of standard contract language.

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Demonstrated intermediate skills with spreadsheets, word processing, and database applications.

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Demonstrated strong analytical and interpersonal skills.

Preferred Qualifications

Bachelors degree in business, finance, accounting, or business related.

Healthcare contracting experience.

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Experience in provider relations, marketing, or analytical experience in a managed care setting.

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Contract negotiation experience.

Physical Requirements:

SH only

Interact with others requiring the employee to communicate information.

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Operate computers and other office equipment requiring the ability to move fingers and hands.

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See and read computer monitors and documents.

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Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location:

Nevada Central Office

Work City:

Las Vegas

Work State:

Nevada

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$26.84 – $42.28

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

All positions subject to close without notice.